Lifeblood: How to Change the World One Dead Mosquito at a Time

November 23, 2011

Alex Perry
(New York, New York: Perseus Books/Public Affairs, 2011)

Although malaria has afflicted humanity for tens of thousands of years, it has been largely eradicated as a public health threat in the West. In the rest of the world, however, the disease still infects more than 200 million people each year, killing 800,000 and wreaking havoc on economies and health and education systems. The disease is most insidious in sub-Saharan Africa, where around 90 percent of infections occur and children under five years old are most vulnerable. Tropical conditions serve as a perfect breeding ground for the mosquitoes that carry malaria parasites, while poverty and conflict hinder efforts to combat the disease.

Still, there is reason for optimism. After decades of neglect, during which the international community paid scant attention to the disease, malaria-related deaths have been reduced by 20 percent over the past ten years as a host of global players have poured money, attention, and resources into malaria-prevention efforts.

Lifeblood, by Alex Perry, focuses on the efforts of Ray Chambers, a former "Master of the Universe" who dreams not just of controlling malaria but of eradicating it altogether. After making his fortune on Wall Street, Chambers turned his attention to philanthropic causes, starting with attempts to revitalize his hometown of Newark, New Jersey. Armed with lessons learned from those efforts, Chambers began his campaign against malaria in 2006 after a chance discussion with his friend, Columbia economist and development expert Jeffrey Sachs. During their conversation, Chambers remarked on the peacefulness of a group of sleeping Malawian children in a photograph that Sachs had shown him, only to learn the children were actually in malarial comas and had almost certainly died soon after the picture was taken. At that moment, Chambers decided that eradication of the disease would be his life's work.

In December 2006, Chambers and media executive Peter Chernin co-founded Malaria No More with the ambitious goal of eliminating all malaria deaths in Africa by 2015. (In recognition of his efforts, Chambers was later named the United Nations secretary-general's special envoy for malaria.) Convinced that universal coverage of insecticide-treated bed nets was the most effective means of combating the disease, Chambers focused his efforts on providing maximum bed-net coverage in some of the most badly affected African countries. Although Lifeblood acknowledges other efforts to fight the disease, such as those championed by the Bill & Melinda Gates Foundation (which tends to emphasize the role of science and technological innovation in solving global problems), the book's primary focus is on Chambers and Malaria No More's bed-net campaign.

Impressed by Chambers' seemingly radical approach and wildly ambitious goals, Perry, TIME's Africa bureau chief, began covering the efforts of Malaria No More in April 2009. As might be expected from a reporter who specializes in long-form journalism, his account is most effective when he is writing about the people and places he encounters while covering the story. They include Henry Okah, the leader of the Movement for the Emancipation of the Niger Delta — a charming if somewhat menacing figure whom Perry meets in Lagos, Nigeria — as well as Apac, Uganda, a town Perry visits twice during the course of his reporting. On his first visit, Perry arrives to find the place paralyzed by malaria. Men with brain damage caused by the disease wander aimlessly around town, the understaffed hospital can't keep up with a steady influx of patients, children miss school, local businesses struggle to stay afloat, and poverty is rampant. When Perry returns at the end of 2010, he finds a town transformed. Streets are bustling, the hospital is less busy, and local business is booming (relatively speaking). Thanks to a successful bed-net campaign, "in the month of October 2010, in the only hospital in the most malarious town on earth," Perry writes, "no child dies of malaria."

Central to Perry's account is the belief that Chambers has transformed the international development field through his efforts. "By drawing heavily on business, Chambers also reinvent[ed] foreign aid, showing how helping can be both efficient and in all our interests," writes Perry. He is alluding, of course, to what many refer to as philanthrocapitalism — a term coined by the Economist's New York bureau chief Matthew Bishop and co-author Michael Green in their 2009 book Philanthrocapitalism: How Giving Can Save the World.Broadly speaking, it's the idea that practices imported from the business world can be used to help solve global problems more quickly and efficiently than traditional aid approaches, which, in Perry's view, tend to be dominated by creaky, turf-conscious NGOs and multilateral organizations.

This is where Perry exhibits a tendency to generalize, describing the development community as a monolith rather than the diverse ecosystem of organizations it is. At the same time, he criticizes the relatively cushy lifestyles and generous travel budgets of aid workers in Africa, while conveniently ignoring Chambers' travels around the continent in private jets and fleets of expensive vehicles.

The efficacy of the philanthrocapitalistic approach remains a topic of vigorous debate. For example, One of Malaria No More's more popular messages is: "$10 buys a net, saves a child's life." While it's true that $10 can buy a bed net, Perry calculates that Malaria No More actually spends closer to $3,500 for every life it saves. It's a small price to pay, for sure, but there's little evidence it represents an improvement on traditional aid approaches to the disease.

Perry also puts too much faith in the idea that corporate self-interest naturally aligns with a desire to solve global problems. He cites the examples of ExxonMobil and mining giant AngloGold Ashanti, both of which decided to join the effort to fight malaria after executives realized that man hours and productivity lost to the disease was costing them money. But while the case studies he presents are compelling, there's little to suggest they depict a fundamental change in the way the two multinationals go about their business.

"Combining business and aid worked because it worked for everyone," AngloGold employee Steve Knowles tells Perry. "Ghana got to control malaria. AngloGold Ashanti got to cut its costs. And a small corner of Africa got to banish the resource curse." That's great when it works, but AngloGold Ashanti also has a dreadful human rights track record and has been criticized by groups like Human Rights Watch and more recently the Public Eye Awards, which named it the "Most Irresponsible Company" of 2011. ExxonMobil's environmental and labor history is hardly spotless. And as Perry himself notes, GlaxoSmithKline once launched a legal case to prevent South Africa from using generic HIV/AIDS drugs — though he fails to explain why this sort of corporate behavior is a thing of the past (when clearly it isn't). It's great when profit and social progress align, but it would be naive to trust corporations to focus exclusively on "doing good," especially when it comes into conflict with "doing well." Perry anticipates this criticism — "There was concern about conflicting interests too. Wasn't it business, aid professionals whispered, that for decades had trapped hundreds of millions of Africans in poverty and war?" — but then drops the point without further explanation.

Obviously there are things the aid and development community can learn from the world of business. But the case for a paradigm shift in the way aid is delivered is, in my view, part of a worrying tendency to embrace the seemingly new and innovative without fully understanding past efforts to address age-old problems. And while it's clear from the book that Chambers is an effective fundraiser who excels at leveraging support from business and political leaders, his methods are hardly revolutionary. Referring to traditional aid organizations, Perry notes that "they were blind to the perennial aid flaw: how removing the responsibility for looking after a people from the leaders of a village — or a town or a country — hurts their ability to do so. Skills are lost, duties forgotten, and a dependency created." This isn't something the international development community is blind to; in fact, it has been grappling with the issue for years. But identifying a problem and implementing a universal solution to it on the ground are two very different things.

So, while Ray Chambers has introduced many good ideas through his campaign into the conversation about malaria, his best idea may simply have been to generate more resources for malaria prevention efforts. And while Lifeblood is an engaging book that will help boost awareness for one of the most pressing public health challenges confronting the developing world today, there are no magic bullets to be found in its pages. When all is said and done, tackling a scourge like malaria will require ingenuity, persistence, and the contributions of multiple stakeholders.

Related Readings

Packard, Randall. The Making of a Tropical Disease: A Short History of Malaria, Johns Hopkins Biographies of Disease. Johns Hopkins University Press, 2011.